Provider Demographics
NPI:1235115221
Name:JACOBSON, MICHELE L (DO)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:14 LITTLE FORK LN
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3517
Mailing Address - Country:US
Mailing Address - Phone:724-527-9525
Mailing Address - Fax:724-527-9683
Practice Address - Street 1:100 EXCELA HEALTH DR STE 302
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9001
Practice Address - Country:US
Practice Address - Phone:724-850-3150
Practice Address - Fax:724-539-2739
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2025-09-10
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Provider Licenses
StateLicense IDTaxonomies
PAOS011955207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H54849Medicare UPIN
054766Medicare ID - Type Unspecified